Open Access Short Research Article

A Survey Showing the Need to Incorporate the Teaching of Critical Appraisal Skills in the Undergraduate Medical Curriculum

Shameen Jaunoo, Hannah L. Adams

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/24238

Aim: Evidence based medicine (EBM) not only increases knowledge but forms the foundations upon which decision making processes are used in medicine. This requires well-conducted research and the ability for doctors to critically appraise literature. The aim of this survey was to gain an insight into the understanding of critical appraisal amongst medical student and trainees, with particular emphasis on the teaching aspect of these skills in the undergraduate curriculum.

Methods: Online questionnaires were distributed within the West Midlands Deanery to final year medical students (from the three medical schools) foundation doctors, core surgical trainees and specialist registrars. The questions asked related to levels of confidence in critical appraisal of scientific papers, undergraduate exposure to the process of critical review and opinions on whether these skills should form a more significant component of the undergraduate curriculum. 

Results: 266 questionnaire responses were received from a range of grades. 127 final year medical students, 62 foundation doctors, 34 core trainees and 43 registrars. Respondents were asked to grade their confidence in critically appraising scientific papers from a choice of no confidence, little confidence, quite confident and very confident. There was a noticeable correlation between level of confidence and grade of respondent. 93% felt critical appraisal teaching was inadequate, with particular emphasis on research methods and paper analysis, with 96% of respondents suggesting this should form a mandatory part of the curriculum.

Conclusion: This survey clearly demonstrates the need to ensure that critical appraisal skills are incorporated into the undergraduate curriculum so that newly qualified doctors begin their careers equipped with the essential skills required to practice evidence-based medicine.

Open Access Short Research Article

Assessment of Association Cytochrome Р450 Gene Polymorphism with Pathogenesis and Course of HСV in Uzbek Population

Azimova Sevara Bakhodirovna, Karimov Khamid Yakubovich

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/24343

Aims: The assessment of polymorphisms CYP2C9*2 (430С>Т; rs1799853) and CYP2E1*1B (–C9896G, rs2070676) role of the genes of cytochrome Р450 in pathogenesis of the chronic viral hepatitis C (HCV) in Uzbek population became the main aim.

Place and Duration of Study: The molecular and genetic study of biomaterial was accomplished under Department of Molecular Medicine and Cellular Technologies of SRIH&BT (Scientific Research Institute of Hematology and Blood Transfusion), MoH RUz in the period of 2013-2016.

Methodology and Study Design: Genotyping assay of polymorphism of the genes under study was accomplished by the standard polymerase chain reaction (PCR). Peripheral blood of 107 patients with diagnosis chronic viral hepatitis C included in the main group and 81 relatively healthy donors (test group) was used for the molecular and genetic study of CYP2Е1*1В and CYP2C9*2 polymorphisms.

Results: Comparative analysis revealed differences in the distribution of allele frequencies of polymorphisms 430C > T CYP2C9 gene and gene C9896G CYP2E1 * 1B in groups of patients with chronic HCV group and population control. In the main group of patients with chronic HCV mutant allele "T » CYP2C9 gene met significantly more frequently in comparison with the control group population. Thus, the highest frequency of the mutant allele of the "T", as compared with the control group was observed in patients with moderate HCV activity. This is the lowest frequency of this genotype was observed in the subgroup of patients with liver cirrhosis. Our studies have shown that the accumulation of the mutant allele «G» CYP2E1 * 1B gene was also the case in almost all sub-groups of patients with chronic HCV. The frequency of heterozygous genotype CYP2E1*1B polymorphism in the population control group was 13.6%. It should be noted that the highest frequency component of genotype C/G was detected in the group of patients with chronic HCV with high activity. The data obtained indicate an association genotype C/G with the activation process of inflammation and fibrotic changes.

Conclusion: The results showed a high frequency of mutant allele "T" polymorphism 430C > T CYP2C9 with HCV, which allows us to consider the CYP2C9 gene as a factor of a favorable outcome of chronic hepatitis C. The association between the expression of CYP2E1 * 1B and progression of the disease with activation fibrosis-formation in individuals of Uzbek population is an important factor in the development of personalized therapy.

Open Access Minireview Article

Stem Cells: A Step Ahead in Regenerative Dentistry with Accent on Orthodontics

Sumita Mishra

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/25182

Stem cells are undifferentiated cells that can give rise to different cell types for performing several specialized functions or remain undifferentiated. They have provided an upfront in various fields of dentistry. In Orthodontics, they provide a step ahead in the field of craniofacial research and development. This article provides an insight into the various aspects of stem cells including their advantages, disadvantages and future perspectives.

Open Access Original Research Article

Acute Effects of Ultrasonic Shears and Monopolar Electrosurgery on Sciatic Nerve Electrophysiology

Chaoyang Chen, John M. Cavanaugh, Srinivasu Kallakuri, Katsumasa Tanimoto, Duan Broughton, Jeffrey W. Clymer, Tamara V. Widenhouse, Joseph F. Amaral

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/25233

Background: When using energized surgical devices in the vicinity of nerves, care must be taken to reduce the risk of thermal or electrical injury. For example, during thyroidectomy, it is critical to avoid damage to the recurrent laryngeal nerve while dissecting and coagulating nearby tissue.

Methods: We compared use of Harmonic ACE+ and Focus ultrasonic shears and monopolar electrosurgery to scissors as a control applied to make incisions in muscle 2 mm from the sciatic nerve in rats. Via electrophysiological monitoring, the compound action potential and conduction velocity were determined over a three hour post-application period. Neuromuscular response was observed by von Frey hair stimulation. Leukocyte infiltration was measured via H&E staining, and impaired axonal transport via β-APP immunohistology.

Results: None of the energized devices had a significantly different compound action potential than scissors, although electrosurgery exhibited prolonged depolarization and repolarization times. Electrosurgery had significantly slower conduction velocity and increased von Frey stimulation force compared to scissors, whereas both ultrasonic devices were not different from the control. No difference was observed between devices for leukocyte infiltration, but electrosurgery had significantly greater β-APP levels than scissors, while again ultrasonic devices were not different.

Conclusion: Electrosurgery caused significantly more neurophysiological damage than scissors. In contrast, the ultrasonic shears were not statistically different than scissors in terms of nerve injury. Harmonic ACE+ and Focus can be used to cut and coagulate tissue near nerves with a low risk of electrophysiological injury.

Open Access Original Research Article

Hypoglycemic, Hypolipidemic and Antioxidant Potentials of Aqueous and Ethanolic Leaf Extracts of Anacardium occidentale in Alloxan Induced Type I Diabetic Rat Model

Olusola Olalekan Elekofehinti, Richard Oseh Osehodion, Tolulope Tosin Adeyelu, Tomisin Happy Ogunwa, Isaac Olatunde, Omosigho Aiwuyo, Oluwamodupe Cecilia Ejelonu

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/24357

Aim: The current study investigated the hypoglycemic, antioxidant and hypolipidemic effects of the aqueous and ethanolic leaf extracts of Anarcardium occidentale in alloxan-induced diabetic rats.

Study Design: In vivo experiment.

Place and Duration of Study: Department of Biochemistry, Adekunle Ajasin University, Akungba-Akoko, Ondo State, Nigeria, between Oct 2011 and Jan 2012.

Methodology: Diabetes was induced in albino rats by the administration of alloxan (150 mg/kg b.w.) intraperitoneally. Aqueous and ethanolic extracts of A. occidentale (200 mg/kg b.w.) were administered by oral gavage once a day for a period of 21 days. The effect of the extracts on blood glucose, lipids, total protein, liver marker enzymes and also on enzymatic antioxidants of defence systems such as superoxide dismutase (SOD), catalase (CAT), enzyme activities, in liver and pancreas were studied.

Results: Both aqeous and ethanolic extracts of A. occidentale reduced the blood glucose, total cholesterol (TC), triglycerides (TG) levels, total protein and activity of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in alloxan-diabetic rats. The extracts also significantly mitigated the increase in malonyldialdehyde (MDA) level, and increased SOD and CAT activities in both liver and pancreas. The levels of high-density lipoprotein (HDL) were significantly increased in A. occidentale treated diabetic rats in comparison with control group. Our findings suggest that both extracts of A. occidentale prevented the alloxan-induced hyperglycemia and increased MDA levels. These effects could be attributed to the presence of bioactive phytochemicals present in these extracts.

Conclusion: These results suggest that A. occidentale extracts possess hypoglycemic, hypolipidemic and antioxidant properties.

Open Access Original Research Article

Height and Body Mass Index Estimated by Alternative Measures in Children with Spastic Quadriplegic Cerebral Palsy and Moderate/Severe Malnutrition

Andrea A. García-Contreras, Edgar M. Vásquez-Garibay, Enrique Romero-Velarde, Rogelio Troyo- Sanromán, Imelda E. Sandoval-Montes, Daniel Illescas Zárate

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/25458

Objective: To demonstrate that alternative measures are reliable predictors of height in children with spastic quadriplegic cerebral palsy (CP) and moderate/severe malnutrition and in healthy children.

Methods: In an intervention study, thirteen patients with CP (10 females and 3 males, with an average age of 9 y 11 m±2 y 3 m) with Gross Motor Function Classification System level V and moderate/severe malnutrition were included. They were compared with 57 healthy participants (31 females and 26 males with an average age of 8 y 7 m±10 m). Weight, height and alternative measures to height were obtained. ANOVA, Student’s t test, the Mann-Whitney U test, the Wilcoxon test, and the Pearson correlation were used.

Results: Significant differences were observed in weight, height and alternative measures between children with CP and healthy children (p < 0.001). In healthy children, knee height (KH) and lower-leg length (LLL) were similar to standing height. The correlation coefficients between height and alternative measures as well as correlations between the heights estimated by alternative measures were higher in children with CP than in healthy children.

Conclusion: KH was the most appropriate measurement to estimate height in children with spastic quadriplegic CP and in healthy children. In the absence of a segmometer, height can be estimated by LLL in children with spastic quadriplegic CP and healthy children. The anthropometric indexes height/age and BMI were more appropriately obtained by the height estimated by KH or LLL.

Open Access Original Research Article

Profound Hyponatremia: Prevalence, Underlying Disorders and Outcome in Tertiary Care Hospital

Parminder Singh, Amarinder Singh, Jasneet Chawla, Amitoj Singh, Satinder Kaur, Manikant Singla

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/23971

Background: Profound hyponatremia (<125 mmol/l) is a serious electrolyte disturbance often encountered in tertiary care setting and is associated with increased morbidity and mortality. Does hyponatremia per se or the underlying disorder contribute to increased mortality remains a controversial point. Clinical records of profound hyponatremia patients were explored with the aim of finding its cause and contribution of hyponatremia in final outcome.

Materials and Methods: All the inpatients with serum sodium ≤125 mmol/L were identified from laboratory data over a period of four months in a tertiary care hospital. Outpatients and cardiac patients were not included in the study. They were classified into three groups according to serum sodium levels in mmol/l (group I: 121-125, group II: 116-120, group III: ≤115). Clinical data was obtained from medical record office. Clinical diagnosis, extent of hyponatremia correction and mortality rates were studied.

Observations: One thousand and fifty patients were identified as having profound hyponatremia (sodium ≤125 mmol/l). Prevalence of profound hyponatremia was recorded as 6.35%. Majority of profound hyponatremic patients (70.54%) had sodium levels in range of 121-125 mmol/l. Very profound hyponatremia (≤115 mmol/l) was noted in 17.6% patients. Mortality rate was significantly higher than the general mortality rate of hospital during that period (8.83% vs 4.6%, p < 0.001). Mortality in group III was highest (12%) followed by patients in group-I (8.42%). Most common cause of hyponatremia was chronic liver disease (20.9%), followed by infectious disease (17.04%), chronic and acute renal disease (15.4%). Diabetes mellitus along with its complications and endocrinological cause were present in 12.1% patients. Other causes include malignancy (11%), neurological (7.04%), pulmonary and trauma (6.4% and 5.17% respectively). Some miscellaneous causes like burns, psychological, skin disease were also noted.

It was observed that patients died mainly because of underlying disease as in majority of subjects (75.72%) hyponatremia was corrected either fully or partially (Na≥ 130 mmol/l and Na ≥ 125 respectively) before demise.

Conclusion: High prevalence of hyponatremia was recorded in inpatients making it a common electrolyte disturbance. Underlying disease and severity of hyponatremia have a bearing on final outcome of patients.

Open Access Original Research Article

Fatigue Syndrome in Multiple Sclerosis

Fatemeh Hosseini, Mansooreh Dehghan Firoozabadi, Ali Mellat

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/24518

Background: Multiple sclerosis (ms) is a chronic and often debilitating disease that mostly affects young people who constitute the active part of community. The incidence of the disease has increased in recent years. Fatigue is one of the common complaints in patients with ms, which may aggravate their disability. However, early diagnosis and treatment have significant impact on their life quality. This study aimed to determine the prevalence of fatigue syndrome in patients with ms and the relationship between frequency of fatigue and depression in ms patients.

Materials and Methods: This descriptive study was carried out on 97 patients suffered from ms. A questionnaire including age, sex, marital status, duration of ms, the disease symptoms and signs were used. For assessing fatigue, iowa fatigue scale (ifs) was applied and for depression assessment, beck depression inventory (bdi) was used. Finally, the obtained data were analyzed using SPSS software.

Results: The study showed a high prevalence of fatigue (66%), which was mostly moderate. The relationship between fatigue and other variables, mainly marital status (p value=0.008), depression (p value<0.001), pyramidal signs (p value=0.039), cerebellar signs (p value=0.007), sensory symptoms (p value<0.001), and visual symptoms (p value=0.017) was statistically significant.

Conclusion: Fatigue is a common compliant in multiple sclerosis. Although, fatigue is a heterogeneous syndrome with various causes, the possibility of its prediction is high in ms patients through clinical evaluation.

Open Access Original Research Article

Attitude of Pregnant Women Attending Ante-natal Clinic towards Adequate Diet in the Prevention of Anaemia in Selected Hospitals in Osogbo

E. O. Adesuyi

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/23427

Aims/Objectives: To assess the attitudes of pregnant women based on their knowledge about anaemia and adequate diet in its prevention.

Study Design: Descriptive.

Place and Duration of Study: The ante-natal clinics: Ladoke Akintola University of Technology, Osogbo and Osun State Teaching Hospital, Asubiaro, Nigeria between January and August 2014.

Methodology: A sample size of 369 was gotten by using Fisher’s rule of thumb. A multi stage sampling technique was utilized. Subjects were chosen from 2 different hospitals in Osogbo. Equal numbers of questionnaires were distributed to the respondents in each hospital. In all, 60 single pregnant women and 309 married pregnant women participated.

Results: Chi-square was used to test two null hypotheses, one was accepted thus the hypothesis restated as there exist a significant difference in knowledge among pregnant women that do believe that anaemia could be cured with drugs alone and those that do not while the other null hypothesis was rejected and confirmed there is no significant difference between perceived income and attitudes about an adequate diet and prevention of anaemia.

Conclusion: Most of the respondents displayed a moderate level of knowledge on anaemia in pregnancy and adequate diet in its prevention. However, this didn’t affect their attitude and level of compliance towards adequate nutrition. Although antenatal care programs distribute iron supplements to pregnant women yet its effectiveness is not well felt. This means that there may be other socioeconomic factors responsible for this non-compliance; further work is therefore needed to validate this. It was suggested that In order to get better compliance, both gynaecologists and midwives should emphasize the importance of taking adequate diet before, during and after pregnancy. Anaemia prevention should be emphasized in the community in order to encourage dietary modifications and promote environmental control of infections contributing to anaemia. This needed to be carried out on a continuous basis and integrated with other on-going.

Open Access Review Article

Will it be a Survivor to Add Clavulanic Acid to Cephalosporins in Order to Overcome Resistance Problem?

Cemal Cingi, Nuray Bayar Muluk, Ethem Şahin, Niyazi Altıntoprak

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/25023

Background: Bacterial resistance is closely associated with the use of antimicrobial agents.

Prolonged therapy with antibiotics can lead to the development of resistance in a microorganism that initially is sensitive to antibiotics, but later it can adapt gradually and develop resistance to antibiotics.

Aims: We reviewed whether clavulanic acid plus cephalosporin combinations help to solve the resistance problem.

Methods: We evaluated and reviewed this topic via “Antibiotic Resistance”, “Cephalosporin and β-Lactamase Inhibitor Combinations” and our suggestions.

Results: Acquired resistance arises from: (1) mutations in cell genes (chromosomal mutation) leading to cross-resistance, (2) gene transfer from one microorganism to other by plasmids (conjugation or transformation), transposons (conjugation), integrons and bacteriophages (transduction). β-Lactamases hydrolyze nearly all β-lactams that have ester and amide bond, e.g., penicillins, cephalosporins, monobactams, andcarbapenems. Serine β-lactamases –  cephalosporinases, e.g. AmpC enzyme – are found in Enterobacter spp. and P. aeruginosa and penicillases in S. aureus. Amoxicillin-clavulanate resistance (MIC >16 microg/ml) in Escherichia coli is reported previously. Therefore, development of new drugs or combination is necessary for the antimicrobial resistance. To manage the Cephalosporin resistance, Cephalosporin and β-Lactamase Inhibitor Combinations, such as Ceftolozane/tazobactam or Ceftazidime/avibactam have been used.

Conclusion: As resistance to cephalosporins have been increasing, cephalosporin + clavulonate combination will be another choice for managing the antibiotic resistance to the cephalosporins.

Our suggestion is based on the success of the clavulonate combination of amoxicillin to manage the antibiotic resistance.